P - 76227REQUEST FOR ELECTRICAL INSPECTION
`� — Q Z o � � � � � Minnesota Board of Electricity ` `- `' �
Z 6J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciry.state.mn.us
Descry� -using the back of the white copy ff ne�ssary - the work covered by this requ�st:
l�t2e i /�� ��t� .✓ N �ect� 6�r,�
GENERAL FEES Outd�r . htinq Standard (a� $1
0 to 400
ALARM, COMMUNICATION, REMOTE CONTR�L, SIG
CIRCURS, CIRCURS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Transformers wer 10 KVA $ 20
Transfortner I Power Supply for Sig� / Outline Lighting (a� $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Servir,e andlor Power Suppty up to 500 Amperes, All
Circuits ar�d Tvuo Inspection Trips Each DweUing Unit @$80
Fee
TIFAMILY DWELLINGS PER UN TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �.
EachAdd'ItlonalUnit@$25 � "°9"�"F°"°'sa`-c`°R"¢°rar � -�
OTHER ADDRIONAL FEES �v� �'r , j`� � ryc6 I
' htlng Retrofit @$.25 r Fodure I by cerldy that I i�peded tlie etectriml ir�stellation d�afbed he on�t6e
Center Pivot Ir� atlon B�m @$40 R01p7�' %��` °ATE
Maniifanh�mfi Hnma Park I nta (df Q9.ri d .�%��`-�
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FGR OFFICE USF fiPL'Y
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�� Q Rough-in Inspectlon Requir�l9 es ❑ No Inspe�tlon Other Than Rough-In: � Ready Now ❑1NOI CeQ
�/� Yau must call the inspector whan readyl Date Ready.
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY
Jab Sfte Str�t Addr�s
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dER artd hereby request inspedion of the electric�l work at
City ,�
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Ftre No. Courny
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Please Provide Txro (2) Phorte Numbers I�Iuding Area Cade
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Llce�e Number Mester Eledridan or Power Limited Technic�an
Licerree Number
Please Provide Two (2) Phone Numbera Including Area Code
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